Introduction

Craniopharyngioma (CP) are benign tumors originating from the sellar/hypothalamic region that are associated with neurological damage, epilepsy and endocrinopathies, which all could negatively affect bone health. It is associated with neurological damage, epilepsy and endocrinopathies, which could bone health and final height.

Methods

In this retrospective study, Dutch/Swedish patients with CP were included if data was available on fractures, bone mineral density (BMD) (T/Z-score), or final height (age >18 years). Data is presented as mean±SD unless stated otherwise. A logistic regression model was developed to evaluate determinants for fractures. Low BMD was defined as T- or Z-score ≤-1, osteoporosis as ≤-2.5 or ≤-2.0, respectively.

Results

We included 177 patients (48% female, 48% childhood-onset disease, median age at last follow-up 45 (range 15-92 years). Fractures occurred in 31 patients (18%); the fracture rate was 5.8 fractures per 1000 person years. Eight patients suffered from multiple fractures (26%). In a multivariable logistic regression model for fractures, significant determinants were female sex (OR 0.3 P=0.004), surgery (OR 0.1, P=0.009), and use of anti-epileptics (OR 3.0, P=0.07). Osteoporosis was not an explanatory variable (OR 2.1, P=0.21). Mean BMD T- and Z-scores were normal: Z-scores for L2-L4, femur neck and total body were 0.0±2.0 (range -3.5 – 6.8), -0.1±1.3 (range -2.7 – 4.7) and 0.1±1.5 (range -4.1 – 3.5), respectively. Osteoporosis occurred in 22 patients (24%) at the age of 53 ± 20 years. Low BMD occurred in 47 patients (50%). Men were less often treated with medication to improve BMD (7% vs. 18%, P=0.02). Mean final height was normal.

Conclusions

Patients with CP have a high fracture rate. Epilepsy treatment was a risk factor and female sex a protective factor for fractures. Mean BMD Z-score was normal, but with a very wide range, resulting in low BMD in 50%. Osteoporosis does not explain fracture risk well. Male patients with CP are potentially undertreated with medication to improve bone health.